Seconds DO Count - ER Diversions

[Bridget Conant]

As much as the city and the Clinic try to deny it, the FACTS are that immediate access to a full service ER can mean the difference between life or death.

ER closures impact surrounding hospitals and create crowded conditions and diversions. WCPN reports on the issues right here in Cleveland:

http://wcpn.ideastream.org/news/be-well ... es-but-how

As has been stated MANY times before, and ignored by the BL boosters,

Dr. James Feldman, an emergency medicine practitioner and researcher in Boston, says that minute or two – or what he calls time to treatment – really matters for some patients.

“I think we have strong evidence that people who have critical illness or injury who have a delayed time to treatment, do worse,” Feldman says.

ER visits continue to increase after implementation of the ACA, as patients cannot find primary care physicians who accept Medicaid.

Jane Dus, chief nursing officer at University Hospitals, says that’s because of more patients and more ambulance squads going to emergency departments, including hers.

“If you go back and you look at just the squad volume, we’ve seen a 56 percent increase in our squad volume over five years,” Dus says. “So we’re getting many more squads coming to us.

And due to UH and Metro having the most number of diversions, UH says:

We just opened up one floor and we will be building more ICU beds, we’ll be building more inpatient beds and building a clinical decision unit right in our ED to take the low-risk admissions and just keep them down there overnight,” Dus says.

How do these FACTS compare to what we are being told by the city and the Clinic?

[Lori Allen _]

I heard from a very credible source that several nights ago, Lakewood was transporting most (if not all) EMS patients to outside hospitals, claiming that Lakewood Hospital was on full restriction. At this time, I checked the CECOMS website, which said that Lakewood Hospital was open and accepting patients. To verify, I called up to Lakewood's ER. They told me that they were not on full restriction and that they were accepting patients. According to my source, some of these patients were transported to St. John's.

[Mark Crnolatas]

Seconds counted when at a few weeks old, our daughter was rushed to the LH ER, and Dr. Baskar literally saved her life in the ER. No ifs, ands or buts.

[Brian Essi]

Bridget,

You are always on top of the facts and have great compassion for the victims in this unfolding tragedy.

Last night CCF and Summers accomplished a 7-0 vote that placed money and property over human lives.

May God have mercy on the souls of all who have supported, promoted and voted this disaster in the making.

[tom monahan]

Brian:

Last night, during rush hour, we ventured out to Crocker Park for some last minute Christmas shopping. While waiting for the traffic to move southbound on the bridge, an ambulance was trying to get up the I-90 ramp. We watched for over five minute while those paramedics tried get through the gridlock. It took us that long to get to the first entrance to the mall and we could still see the squad at the next light south of that entrance trying to maneuver its way toward St. John's Hospital. I said a prayer for the poor soul inside and thought that same scenario is going to be repeated over and over again when Lakewood's squads try to get people to a real ER or hospital.

[Dan Alaimo]

We have two traffic choke points: Warren and McKinley. There are ways around both, but they are the most direct routes to the other hospitals from central Lakewood.

[Lori Allen _]

In the past two weeks, there was an EMS call for someone with chest pains. As we all have heard, anything that could be heart related, stroke etc. falls into the "golden hour" category. From the beginning of treatment until this person made it through the doors at Metro 42 minutes had already passed. That is 42 minutes into the golden 60 minutes. Can we really make it from Lakewood to Metro and back in 8 minutes? Unfortunately, people will die as I suspect we may have lost some already. I don't need tongue lashings from all the Build people or the Fire Chief. How about some actual documentation here on the Deck to show us how great our response times are. REAL DOCUMENTATION, not just words!

[Lori Allen _]

Perhaps it is time to rename Lakewood Hospital to Lakewood Urgent Care. Attached are police reports about incidents that should have been able to be treated at Lakewood Hospital that were going to be or were diverted to other hospitals.

One incident was a person that had overdosed on Nyquill & pills. The person's family had taken the person to Lakewood Hospital, where it was being contemplated whether or not the person should be transported to Fairview or CCF Main Campus. Why could this person not be taken to Metro?

The second incident is a person that fell and hit his head on the sidewalk and also cut his finger. This case was diverted to Fairview.

The third incident was a person with COPD. They were transported to Metro.

Personally identifying information for some individuals has been removed out of respect for them.

On another note, here is perhaps another reason for ER diversions. Lakewood (and quite possibly other cities) not only charges taxpaying citizens a flat rate for their EMS ride, but also charges a mileage fee and supply fees. If Fairview is double the distance, would that not mean double the money for the city?

If you are taken to Lakewood Urgent Care and you can't be treated there and you are sent to CCF Main or Fairview, you will likely be paying mileage charges, but also two ambulance rides. How many people's insurance companies will pay for two rides in one day?

[Lori Allen _]

Hi all,
Just wanted to inform you that we had another EMS run this week where the patient was taken to Fairview. Total time of the call was 57 minutes. So, we had one squad not available to the Lakewood citizens for almost an hour. How about CCF's Mobile Stroke Unit? What if there are multiple stroke calls at the same time? I can't figure out why our squads can make it to Metro and back in 8 minutes but it takes longer when they go to Fairview. Something appears to not be adding up.

[Corey Rossen]

Hi all,
Just wanted to inform you that we had another EMS run this week where the patient was taken to Fairview. Total time of the call was 57 minutes. So, we had one squad not available to the Lakewood citizens for almost an hour. How about CCF's Mobile Stroke Unit? What if there are multiple stroke calls at the same time? I can't figure out why our squads can make it to Metro and back in 8 minutes but it takes longer when they go to Fairview. Something appears to not be adding up.

When you say 57 minutes - I imagine that includes the amount of time getting to the site, onsite assessing and resuscitating (or whatever care is necessary) and transporting to a hospital. Is that correct?

When you say 8 minutes - is that just drive time?

[Jim O'Bryan]

When you say 57 minutes - I imagine that includes the amount of time getting to the site, onsite assessing and resuscitating (or whatever care is necessary) and transporting to a hospital. Is that correct?

When you say 8 minutes - is that just drive time?[/quote]

Corey

Average times drive times... From Detroit and Warren, north side Detroit, heading south on Warren after the light changed to green.

Fairview - CLOSEST BY TIME taking only 6 minutes and 7 seconds was ...Ambulance Time: 6:07.35, Driving Time: 8:07.35 - Stops 2:00.00

Avon Lake Next closest - Ambulance Time: 8:43.46, Driving Time: 11:07.46 - Stops 2:20.00

Metro General, Ambulance Time: 12:40.05, Driving Time: 14:413.83 - Stops 2:13.02 (ambulances might be able to avoid some of the back tracking)

St. John's - Ambulance Time: 13:31.03, Driving Time: 15:443.05 - Stops 2:13.02

From Lakewood Hospital The Discussion - http://www.lakewoodobserver.com/forum/v ... ime#p92731

What I also found out figures into this is, how far they have to go in the hospital to move patient. How open beds are, as they do not dump patients off, how far back they have to travel to the ambulance, and clean-up after patient depending on why they were in the ambulance. Some of these times can be moot though, as they prepare ambulance on the way back to the station.

Fun fact, 15 minutes into 2016 we ran out of ambulances, and you never knew it. 3 people stabbed on Emerson, 3 car accident on Mars, domestic violence.
Rocky River was ready to cover, as was Cleveland, though it was not needed.

"Westshore" police and fire have been working on these plans for decades, and continue to work on them. One of the most visible groups is Westshore SWAT, where police from all cities join to handle emergencies that are personnel intensive, and tougher than day to day. Like police and fire from all westside communities, are ready to cover each other and work together in case of emergency, tornado, plane crash, terrorism, etc. Having witnessed many of the training sessions and meetings, they are constantly training and seamless in the changeover when needed.


Westshore SWAT practices at house on Sloane Ave. (photo by Rhonda Loje)


Westshore fire departments working on working together.



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[Alex Belisle]

I asked this very question last night at the Citizens Police Academy and got a similar answer plus the Fire dept. has EMT's who can help stabilize victims, even though they themselves don't have ambulances, if Lakewood runs out of ambulances.

[scott gilman]

No one complained prior to October 1999 when Lakewood Hospital EMS only had 2 ambulances with no back up the run volume was handled,however some calls were held by dispatch until a squad became available. Since then we have added a third ambulance and upgraded all 3 fire apparatus to include trained personnel with the needed equipment that can be used to stabilize a patient. This model is used throughout the country and makes good use of the resources.
Run time is measured by the time it takes the dispatcher to process the call, alert the responding unit or units, the time it takes to leave the station and reach the patient, the time it takes to treat the patient and transport them to the ambulance, the time it takes to drive to the hospital, the time it takes to transfer the patient to a hospital bed, the time it takes to restock the ambulance, complete the patient care report and the time it takes to return to the city. So a 57 minute total time for a call seems good to me.
Given the run volume from 2015 of 5354 EMS runs to adequately cover that volume requires 2.1 ambulances. Of that total of runs 21.7% did not require transport to the hospital, 61.2% were transported to Lakewood Hospital, 13.7 % to Fairview, 2.4% to Metro and .08% to other hospitals.

[Patrick Wadden]

No one complained prior to October 1999 when Lakewood Hospital EMS only had 2 ambulances with no back up the run volume was handled,however some calls were held by dispatch until a squad became available. Since then we have added a third ambulance and upgraded all 3 fire apparatus to include trained personnel with the needed equipment that can be used to stabilize a patient. This model is used throughout the country and makes good use of the resources.
Run time is measured by the time it takes the dispatcher to process the call, alert the responding unit or units, the time it takes to leave the station and reach the patient, the time it takes to treat the patient and transport them to the ambulance, the time it takes to drive to the hospital, the time it takes to transfer the patient to a hospital bed, the time it takes to restock the ambulance, complete the patient care report and the time it takes to return to the city. So a 57 minute total time for a call seems good to me.
Given the run volume from 2015 of 5354 EMS runs to adequately cover that volume requires 2.1 ambulances. Of that total of runs 21.7% did not require transport to the hospital, 61.2% were transported to Lakewood Hospital, 13.7 % to Fairview, 2.4% to Metro and .08% to other hospitals.

Thanks for detailed and very specific answer.

[Pam Wetula]

No one complained prior to October 1999 when Lakewood Hospital EMS only had 2 ambulances with no back up the run volume was handled,however some calls were held by dispatch until a squad became available. Since then we have added a third ambulance and upgraded all 3 fire apparatus to include trained personnel with the needed equipment that can be used to stabilize a patient. This model is used throughout the country and makes good use of the resources.
Run time is measured by the time it takes the dispatcher to process the call, alert the responding unit or units, the time it takes to leave the station and reach the patient, the time it takes to treat the patient and transport them to the ambulance, the time it takes to drive to the hospital, the time it takes to transfer the patient to a hospital bed, the time it takes to restock the ambulance, complete the patient care report and the time it takes to return to the city. So a 57 minute total time for a call seems good to me.
Given the run volume from 2015 of 5354 EMS runs to adequately cover that volume requires 2.1 ambulances. Of that total of runs 21.7% did not require transport to the hospital, 61.2% were transported to Lakewood Hospital, 13.7 % to Fairview, 2.4% to Metro and .08% to other hospitals.

Thanks for detailed and very specific answer.

In 2015, 61.2% went to Lakewood hospital and now will have to travel further and with more risk for stroke victims, those bleeding out, heart attack , seizure and other serious injuries or health issues. Prior to Oct 1999 ...the ambulances only had a few minutes to go to LH ER and other companies were likely called if both Lakewood units were busy. You can't tell me that I would call in w chest pains & no other EMS would have been called. Really? The dispatch took on the risk of holding Emergency calls? Is Chief Gilman quoting EMS runs by Lakewood EMS or ALL EMS runs for Lakewood Citizens in 2015? I would like to know the answers to these and other questions before I would consider this to be a detailed and vey specific and VALID answer.

When minutes count, these people will be at risk for death and/or reduced positive outcomes. It is not appropriate for the most densely populated city between NYC & Chicago to lose an ER attached to a full service hospital. The new emergency care will NOT be complete because it is not attached to a hospital. The prognosis for emergency care for Lakewood residents is very poor in 2016 and forward unless we stop the Goliath Cleveland Clinic from stripping us of full service healthcare in Lakewood.

The operative phrase is SECONDS DO COUNT..